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Le recueil de sperme chez le blessé médullaire

Sperm retrieval in spinal cord injury patients

Résumé

Les troubles génito-sexuels sont très fréquents chez les blessés médullaires. La dysérection et la dysfonction éjaculatoire (anéjaculation et éjaculation rétrograde) sont à l’origine d’une insatisfaction sexuelle et d’infertilité.

La stimulation pénienne vibratoire (vibromassage) représente le traitement de première intention de l’anéjaculation, avec des taux de succès d’environ 66%. Lorsqu’une stimulation pharmacologique sympathomimétique y est associée (midodrine, Gutron®), l’éjaculation est obtenue chez plus de 85% des patients.

L’électroéjaculation ou les techniques chirurgicales, plus contraignantes, ne seront généralement proposées qu’en seconde intention.

Le traitement par midodrine présente une certaine efficacité dans le traitement de l’éjaculation rétrograde, par fermeture du col vésical.

Abstract

Infertility is a major issue for men with spinal cord injury (SCI). Male infertility is due to a combination of ejaculatory dysfunction and abnormal sperm quantity and quality. The reported ability to ejaculate during sexual stimulation or masturbation is about 15%.

Techniques to remediate ejaculation have vastly improved the fertility potential of men with SCI. Penile vibratory stimulation (PVS) to induce ejaculation is now recommended as first-line treatment due to its safety and relative efficacy. PVS can also be used at home for fertility purposes with success rates of more than 70%.

Pharmacological treatments can be associated with PVS to enhance ejaculation. Midodrine, an alpha1-adrenergic agonist, has been recently used with success rates of 66% in SCI patients who failed PVS alone. PVS with midodrine can now be considered as second-line treatment for anejaculation, after PVS and before electroejaculation. It is a safe procedure, but requires cardiovascular monitoring.

PVS with midodrine can also be effective in the treatment of retrograde ejaculation by inducing bladder neck closure.

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Correspondence to Jean -Gabriel Previnaire or Godeleine Lecourt or Gaétan Stoquart or Jean -Marc Soler or Pierre Plante.

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Previnaire, J.-., Lecourt, G., Stoquart, G. et al. Le recueil de sperme chez le blessé médullaire. Androl. 18, 64–69 (2008). https://doi.org/10.1007/BF03040381

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Mote clés

  • blessé médullaire
  • éjaculation
  • vibromassage
  • midodrine

Key words

  • ejaculation
  • midodrine
  • penile vibratory stimulation
  • spinal cord injury